2011, 09-13 Permit App: 11002848 Plumbing Fixtures•-h
Permit Center
11707E Sprague Ave, Suite 106
r�V alley Spokane Valley, WA 99206
ra`- ✓ (509)688-0036 FAX: (509)688-0037
Community Development www.spokanevallcv oro.com
Plumbing Permit Application
Mail or Fax To: 77 ,,
None's Excavating, Inc. 9 L V {{,, yyV O N
PO Box 574
Veradale, WA 99037
Fax: 892-0432
WV*:6 ll06 'El'da9 anvil 1) Alaaa?:1
PERMIT NUMBER: 1 I — /2o4 -Ib
PERMIT FEE:
❑ Commercial ® Residential
SITE ADDRESS: 3505 N Lockwood
Building owner
DESCRIPTION OF WORK
HOF UNITS
Name: Plotzki
Phone: 9249258
Fax:
TOTAL AMOUNT
Address: SAME
City:
State:
Zip:
Contractor
$6.00
=
6.00
Name: Norm's Excavating, Inc
Phone: 509/928-0580
Fax: 509/892-0432
Address: PO Box 574
City : Veradale State:
WA
Zip: 99037
License No: NORMSEI972BM
City Business License No:
Contact
X
56.00
=
Name: Sheila Gibbons
Phone: 928-0580
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
AUTHORIZED SIGNATURE:
, lr!7/ /4cr rc/
e•d ZEfOZ6860S
2uneneox3 swuo.
REVISED 2/26/05
e60:60 TT ET daS
DESCRIPTION OF WORK
HOF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
1
X
$6.00
=
6.00
2
URINALS
X
$6.00
=
3
TUBS
X
56.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
1
X
$6.00
=
6.00
5
SINKS
LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
1
X
56.00
=
6.00
6
DISHWASHER
X
56.00
=
7
CLOTHES WASHER
X
56.00
8
GARBAGE DISPOSAL
X
56.00
=
9
WATER SOFTENER
X
56.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS SEE MECHANICAL
X
$6.00
=
11
FLOOR DRAINS
AREA, CASE, COIL. TRENCH, CONDENSATE
X
56.00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
56.00
=
13
FOUNTAINS, DRINKING
X
56.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
1
X
5600
=
6.00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
56.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
$6.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS. BOILERS
X
$6.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
56.00
21
PRNATE SEWAGE DISPOSAL/SYS
X
52000
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
METHOD OF PAYMENT:
0 CASH 0 CHECK
Cara see cover sheet
® VISA 0 MASTERCARD
EXPIRES:TOTAL
SUBTOTAL
24.00
PROCESSING FEE
37.00
PERMIT FEE DUE:
61.00
AUTHORIZED SIGNATURE:
, lr!7/ /4cr rc/
e•d ZEfOZ6860S
2uneneox3 swuo.
REVISED 2/26/05
e60:60 TT ET daS